Harm reduction among injecting drug users: evidence of effectiveness

Jo Kimber, Norah Palmateer, Sharon J. Hutchinson, Matthew Hickman, David J. Goldberg, Tim Rhodes

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

This chapter synthesises and evaluates the available direct evidence relating to the impact of needle and syringe programmes (NSPs), opioid substitution treatment (OST), drug
consumption rooms (DCRs), and peer naloxone distribution (PND) on HIV/hepatitis C (HCV) incidence/prevalence, injecting risk behaviour and overdose-related mortality. To achieve this, we conducted a review of reviews; a systematic and explicit method used to identify, select and critically appraise relevant findings from secondary level research (systematic reviews and/or meta-analyses) into an evidence briefing. In the absence of high-quality reviews, appraisal of the evidence was supplemented with a targeted review of the primary literature. We find that there is sufficient review-level evidence that OST reduces HIV transmission, while the evidence in support of NSPs reducing HIV transmission is more tentative, and for DCRs currently insufficient. There is tentative evidence that OST has limited effectiveness in reducing HCV transmission, and insufficient evidence to support or discount NSPs or DCRs’ ability to reduce HCV transmission. There is sufficient review-level evidence that NSPs, OST and DCRs reduce self-reported injecting risk behaviour. There is sufficient
review evidence that OST reduces risk of overdose mortality, but insufficient evidence to support or discount the effect of DCRs or PND on overdose deaths at the community level. Our review shows evidence in support of a variety of harm reduction interventions but highlights an uneven presence of high-quality review evidence. Future evaluation of harm reduction programmes should prioritise methodologically robust study designs
Original languageEnglish
Title of host publicationHarm Reduction: Evidence, Impacts and Challenges
EditorsTim Rhodes, Dagmar Hedrich
PublisherThe European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
Pages115-163
Number of pages49
VolumeChapter 5
ISBN (Print)9789291684199
Publication statusPublished - Apr 2010

Publication series

NameEMCDDA
Volume10

Fingerprint

Opiate Substitution Treatment
Harm Reduction
Drug Users
Syringes
Needles
HIV
Naloxone
Risk-Taking
Aptitude
Mortality
Hepatitis C
Meta-Analysis
Incidence
Research

Keywords

  • injecting drug use
  • opioid substitution treatment
  • NSPs
  • HIV
  • review methods
  • DCRs

Cite this

Kimber, J., Palmateer, N., Hutchinson, S. J., Hickman, M., Goldberg, D. J., & Rhodes, T. (2010). Harm reduction among injecting drug users: evidence of effectiveness. In T. Rhodes, & D. Hedrich (Eds.), Harm Reduction: Evidence, Impacts and Challenges (Vol. Chapter 5, pp. 115-163). (EMCDDA; Vol. 10). The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).
Kimber, Jo ; Palmateer, Norah ; Hutchinson, Sharon J. ; Hickman, Matthew ; Goldberg, David J. ; Rhodes, Tim. / Harm reduction among injecting drug users: evidence of effectiveness. Harm Reduction: Evidence, Impacts and Challenges. editor / Tim Rhodes ; Dagmar Hedrich. Vol. Chapter 5 The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2010. pp. 115-163 (EMCDDA).
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Kimber, J, Palmateer, N, Hutchinson, SJ, Hickman, M, Goldberg, DJ & Rhodes, T 2010, Harm reduction among injecting drug users: evidence of effectiveness. in T Rhodes & D Hedrich (eds), Harm Reduction: Evidence, Impacts and Challenges. vol. Chapter 5, EMCDDA, vol. 10, The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), pp. 115-163.

Harm reduction among injecting drug users: evidence of effectiveness. / Kimber, Jo; Palmateer, Norah; Hutchinson, Sharon J.; Hickman, Matthew; Goldberg, David J.; Rhodes, Tim.

Harm Reduction: Evidence, Impacts and Challenges. ed. / Tim Rhodes; Dagmar Hedrich. Vol. Chapter 5 The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2010. p. 115-163 (EMCDDA; Vol. 10).

Research output: Chapter in Book/Report/Conference proceedingChapter

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AB - This chapter synthesises and evaluates the available direct evidence relating to the impact of needle and syringe programmes (NSPs), opioid substitution treatment (OST), drugconsumption rooms (DCRs), and peer naloxone distribution (PND) on HIV/hepatitis C (HCV) incidence/prevalence, injecting risk behaviour and overdose-related mortality. To achieve this, we conducted a review of reviews; a systematic and explicit method used to identify, select and critically appraise relevant findings from secondary level research (systematic reviews and/or meta-analyses) into an evidence briefing. In the absence of high-quality reviews, appraisal of the evidence was supplemented with a targeted review of the primary literature. We find that there is sufficient review-level evidence that OST reduces HIV transmission, while the evidence in support of NSPs reducing HIV transmission is more tentative, and for DCRs currently insufficient. There is tentative evidence that OST has limited effectiveness in reducing HCV transmission, and insufficient evidence to support or discount NSPs or DCRs’ ability to reduce HCV transmission. There is sufficient review-level evidence that NSPs, OST and DCRs reduce self-reported injecting risk behaviour. There is sufficientreview evidence that OST reduces risk of overdose mortality, but insufficient evidence to support or discount the effect of DCRs or PND on overdose deaths at the community level. Our review shows evidence in support of a variety of harm reduction interventions but highlights an uneven presence of high-quality review evidence. Future evaluation of harm reduction programmes should prioritise methodologically robust study designs

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VL - Chapter 5

T3 - EMCDDA

SP - 115

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A2 - Rhodes, Tim

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PB - The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)

ER -

Kimber J, Palmateer N, Hutchinson SJ, Hickman M, Goldberg DJ, Rhodes T. Harm reduction among injecting drug users: evidence of effectiveness. In Rhodes T, Hedrich D, editors, Harm Reduction: Evidence, Impacts and Challenges. Vol. Chapter 5. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). 2010. p. 115-163. (EMCDDA).